Abstract Background/Aims Systemic sclerosis (SSc) primary heart involvement (pHI) is frequent, often subclinical, and portends poor outcomes. Cardiovascular magnetic resonance (CMR) enables multiparametric myocardial tissue characterization for early detection. Nailfold capillaroscopy (NFC) provides direct assessment of peripheral microangiopathy, but its relationship to cardiac pathology remains unclear. Methods SSc patients without ischaemic heart disease, established pHI, diabetes, or ≥ 2 cardiovascular risk factors underwent baseline CMR and NFC within 6 months. NFC was categorized as non-specific, early, active, or late patterns. CMR (3T Philips Achieva) measured myocardial perfusion reserve (MPR); abnormal myocardial tissue (MT) was defined by ≥ 1 of: non-ischaemic late gadolinium enhancement (LGE) scar, native T1 1050 ms, or extracellular volume (ECV) 30%. Continuous variables were compared with ANOVA and categorical with χ² tests. Results Eighty patients were recruited (mean age 55, 73% female, 32.5% dcSSc). Active and late NFC patterns associated with dcSSc. MPR was comparable across NFC groups. Forty patients (50%) had abnormal CMR: 43.5% non-specific, 56.2% early, 63.7% active, 50.0% late. LGE-positive scar occurred across groups (∼35-41%). Native T1 increased across NFC patterns (1244 ±59 → 1256 ±105 ms). ECV was numerically higher in specific vs non-specific patterns (29.6% vs 30.2-32%). NT-proBNP was higher across groups (p = 0.032). Conclusion Subclinical myocardial tissue abnormalities occur across all NFC patterns, with highest frequency in active SSc. Increasing diffuse myocardial fibrosis and NT-proBNP across specific patterns suggest progressive myocardial strain. Findings support central-peripheral vasculopathy link, warranting validation in larger cohorts. Disclosure C. Sieiro Santos: None. R. Dumitru: None. G. Abignano: None. L. Bissell: None. S. Plein: None. F. del Galdo: None. M. Buch: None.
Santos et al. (Wed,) studied this question.